Tuesday, November 7, 2017

Unintelligible Medicine

This Blog Post Written By

Krista Amira Calvo

“Los
medicos no saben nada”(doctors don’t know anything) is a common phrase echoed
in the halls of the few and far between migrant clinics in the American
Southwest and along the Western Coast of the United States. This phrase is very
disconcerting, as it embodies the way that the majority of migrants feel about
the Western healthcare system. There is a wild misconception that migrants who
cross the border from Mexico into Arizona are all Mestizo. This misinformation
stems from language fed to us by the press that generalizes Latinx peoples as
all having come from one place, that place being Mexico. In actuality, the
migrant diversity is very wide; border crosser demographics include Hondurans,
Guatemalans, El Salvadorans, Panamanians and the occasional Belizean.

These
populations can be broken down into even further marginalized groups of the
Indigenous populations of the aforementioned countries. With Spanish being broadly
spoken in Mexico and Central America, these Indigenous communities are at a
loss in regards to communication with Spanish speakers and, more critically,
the English speaking clinicians that struggle to provide adequate healthcare on
the U.S. side of the border.

Image by John Barletti

The Triqui people, Indigenous to
Oaxaca, speak Trique, a language belonging to a Mixtecan branch of Mixtec
languages. Trique is a
tonal, pre-Columbian language, and is as related to Spanish as English is to
Mandarin (Porzucki 2016). In
addition, four varieties of Trique are spoken in different geographical regions
of Oaxaca. The inability to communicate with their peers on the farms,
overseers and other staff hinder their ability to acquire the basics they need
to survive; among these needs is proper medical care.

Clinics accessible to migrants are
often under-funded public facilities that take patients from every walk of
life. From the moment a migrant steps in the door, there is an aversion to treatment
because of anticipated communication issues. This is due largely to the fact
that interpreters in these clinics are very few and far between, and the
majority only speak Spanish.

One of the most common issues faced is in
obtaining accurate information about the patient’s symptoms and medical
history, a seemingly impossible feat when such an aggressive language barrier
is the elephant in the room. In his 2013 book, Fresh Fruit Broken Bodies, Dr. Seth Holmes tells the story of one
such Triqui migrant named Bernardo. Bernardo was admitted to a local hospital
with complaints of stomach-pain. There was no translator available to create a
communication pathway between Bernardo and his physician, forcing his Mixtec
daughter in law who spoke no Trique and minimal English to serve as the
linguistic liaison. Despite doing her best, his medical history was summed up
as Bernardo having been an “older boxer who wonders if possibly the blunt
trauma to his abdomen could contribute to his present condition.” The physician,
who assumed Bernardo to be a hispanic who spoke poor Spanish, noted that he
“tended to perseverate on unrelated things from the questions that were asked,
but these things were usually not translated to me.” In his frustration, the
physician wove his own story in order to fulfill the requirement of creating a
medical history for Bernardo, but decided that Bernardo did not have one at
all.

Due to the temporal and linguistic
limitations of the medical interview, the physician was unclear about the
location and quality of the pain (Holmes 2013). What Bernardo was desperately
trying to communicate to the physician is that he believed his pain was caused
by a lifetime of hard labor in the fields in conjunction with physical abuse at
the hands of the U.S. funded Mexican military. The juxtaposition of Bernardo’s
experiences with what was documented on his chart is alarming. More shocking
still was the lack of care given to explaining a follow up to Bernardo; he left
the hospital “against medical advice” and was charged $3,000 for a visit that
offered him nothing at the end of the day.

Occurrences like these exemplify one
of the major problems Indigenous peoples face when they encounter Western
medicine, a mostly linguistic issue that can exacerbate the deaths of those who
have no means of communication with Spanish or English speakers. The argument
against this is always the “well, learn English” argument, but English course
are inaccessible to the marginalized migrant. So what is the government doing
to rectify these issues?

All health care facilities receiving public money are
under legal obligation by both state and federal law to provide interpreters to
every patient who needs one, and very few health care providers have made
Indigenous farmworkers an explicit priority (Raff 2015). This is an unknown
fact to many Indigenous peoples who, because of language barriers, have no
awareness of what they are entitled to. However, these things are starting to
shift. In 2016, California overturned the ban on provision of bilingual
education. This positive movement allowed for the progression of migrants out
of the field and into the health care setting, serving as interpreters for
marginalized people like Bernardo. Indigenous Interpreters Plus, an
organization started at Natividad Hospital in Salinas, California, aims to
train interpreters who speak the rich Indigenous languages of Oaxaca and other
parts of Mexico.

The accessibility of
proper healthcare is crucial to quality of life, and when something as simple
as having the right interpreter stands between a patient, life and death, it is
an indicator that something needs to change. Organizations like Indigenous
Interpreters Plus can have a huge effect on migrant mortality rates and the
overall experience of the migrant worker in the U.S. Already victims of
structural violence and systemic racism, one’s language should not be the death
of them. For the Indigenous populations of Mexico who come to the U.S. for
something better, the relationship between language and mortality is beginning
to dissipate.

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Disclaimer

What I post here is intended only as a forum to discuss ideas. Please be aware that referred to research or sources evolve over time so the documents referred to on this blog may be superseded by new information.

Oh, and BTW I use the following broad definition of Health Literacy:“A health literate person is able to use health concepts and information generatively—applying information to novel situations. This is critical to our efforts to prepare the public to react to complex public health emergencies.”(From invited paper presented by me - Surgeon General’s Report on Health Literacy, September 7 2006, Bethesda Maryland http://www.surgeongeneral.gov/topics/healthliteracy/toc.html)